부산대학교 도서관

Introduction Renal traumas are not common trauma types that consititutes 1-5% of all traumas and 10% of abdominal traumas (1). There is a controversy of preferring conservative or surgical approach [...]
Objectives: Kidney traumas constitute a small part of all abdominal traumas. There is debate about whether to choose a conservative or surgical approach. Nephrectomy is the most common surgical treatment for renal trauma. Conservative treatment may be considered for preservation of renal function. Fourth and fifth degree injuries are associated with poor functional outcomes. Materials and Methods: Kidney trauma admitted to a third-degree reference center was evaluated. Renal trauma assessment was performed with the help of computed tomography. Age, gender, laterality, and hemoglobin levels were evaluated. cases that were followed conservatively and underwent surgery were recorded. Results: The median age of the patients was 25 years (18-44 years). 71.4% (n=15) of the cases were conservatively managed. Surgical repair of the injured kidney was preferred for 1 of the cases (4.8%). Nephrectomy was performed for 2 cases (9.5%) and embolization was preferred 2 cases (9.5%). Surgical repair and removal of foreign body was performed for only 1 case with penetrating renal trauma (4.8%). All grade I and II traumas were treated conservatively. One of grade III traumas underwent surgical repair, 1 of them underwent surgical repair and removal of foreign body and the other 4 patients were treated conservatively. One of grade IV traumas was performed nephrectomy, 1 of them underwent embolization and the other 4 were conservatively treated. For the patients with grade V traumas, 1 underwent nephrectomy and 1 was treated with embolization. Conclusion: Different success rates have been reported for treatment approaches according to the literature. Both treatments have advantages and disadvantages. Conservative treatment is at the forefront in many patients, albeit at a high level. Interventions should be planned for hemodynamically unstable patients. This approach seems beneficial given its efficacy and safety. Thus, unnecessary kidney loss will be prevented. Key Words: Renal Trauma, Nephrectomy, Conservative Amac: Bobrek travmalari tum karin travmalarinin kucuk bir kismini olusturur. Konservatif mi yoksa cerrahi yaklasim mi tercih edilecegi konusunda tartismalar vardir. Nefrektomi, renal travmanin en yaygin cerrahi tedavisidir. Konservatif tedavi bobrek fonksiyonunun korunmasi icin dusunulebilir. Dort ve besinci derece yaralanmalar kotu fonksiyonel sonuclarla birlikte beraberligi mevcuttur. Gerec ve Yontem: Ucuncu derece referans merkezine kabul edilen bobrek travmalari degerlendirildi. Renal travma degerlendirmesi bilgisayarli tomografi yardimi ile yapildi. Yas, cinsiyet, lateralite, hemoglobin seviyeleri degerlendirildi. Konservatif takip edilen ve cerrahi uygulanan olgular kaydedildi. Bulgular: Hastalarin medyan yasi 25 (18-44 yil) olarak saptandi. Olgularin %71,4'u (n=15) konservatif olarak takip edildi. Yaralanan bobregin cerrahi onarimi olgularin 1'inde (%4,8) tercih edildi. Iki olguya (%9,5) nefrektomi yapildi ve 2 olguya (%9,5) embolizasyon tercih edildi. Penetran renal travmali sadece 1 olguda (%4,8) cerrahi onarim ve yabanci cisim cikarildi. Sonuc: Literature gore tedavi yaklasimlari icin farkli basari oranlari bildirilmistir. Her iki tedavinin de avantajlari ve dezavantajlari vardir. Konservatif tedavi, yuksek dereceli de olsa bircok hastada on plandadir. Hemodinamik acidan stabil olmayan hastalar icin mudahaleler planlanmalidir. Bu yaklasim, etkinligi ve guvenligi goz onune alindiginda faydali gorunmektedir. Boylelikle gereksiz bobrek kaybi onlenmis olacaktir. Anahtar Kelimeler: Renal Travma, Nefrektomi, Izlem